Lecture of cultured fibroblasts

2021-03-22 12:00 AM

Human vaginal metastasis is usually taken easily, except for cases of metastasis close to the urethra, rectum. Pulmonary metastases if there are only a few nuclei in one lobe or one side of the lung can cut the lungs to remove the metastatic nucleus.

Define

Cultured fibroblasts are an abnormal proliferation of cultured cells involved in the pregnancy. Cultured fibroblasts are malignant diseases of cultured cells, having invasive properties and the ability to secrete hCG (human chorionic gonadotropin). Cultured fibroblasts include invasive fibroblasts and pregnancy.

Epidemiology

Myoblastic cancer feeds 1 / 40,000 pregnant women, nearly 50% after pregnancy, 25% after a miscarriage, 22% after normal birth and 2-3% after giving birth. Cultured fibroblasts have a rate of 1 / 1,200 pregnancies in the US and 1 in 120 pregnancies in Southeast Asia.

The incidence of the disease increases in women with low living standards, in developing countries.

Older women are at higher risk.

Criteria for the classification of the risk of pregnancy turning into cultured fibroblast cancer according to WHO

                                                                                                  Point

 

0

1

2

4

Species

Half

Totality

Occur again periodically

 

Uterine size for gestational age (month)

< 1

>1

>2

>3

hCG (mUI / liter)

<5.000

>50.000

>100.000

>106

Diameter of the glandular follicle (cm)

 

<6

>6

>10

Age (years)

 

<20

>40

>50

Combination factor

Not available

> 1 factor

 

 

Associative factors: Hypertension, pre-eclampsia, hyperthyroidism, scattered blood clotting disorders in the lumen, occlusion cell culture.

Score if <4 is low risk,> 4 is high risk.

Pathology

There are manifestations of overproduction and inversions of cultured cells, not visible vegetable spines, necrotic bleeding phenomenon, direct invasion of uterine muscle, spread through the bloodstream to other organs. So the most common metastases are in the lungs, liver, brain, vaginal subframe, spleen, intestines, kidney.

Sometimes it is difficult to differentiate between cultured fibroblasts and clinically invasive neoplasm, but only in terms of anatomical differentiation. Invasive pregnancy is a benign tumor that develops after pregnancy, it invades the uterine muscular layer due to its direct or intravenous spread, its rate of distal metastasis is about 15%, most commonly the lung. and vagina. The feature of the tumor is also an edematous spiny image with overproduction and the most common is dysplasia of fibroblasts cultured outside the uterus.

Diagnose

Eggs, ectopic pregnancy, miscarriage, normal delivery.

Seaweed

Since cultured fibroblasts cause direct damage to the uterus, the time to appear may be relatively short or long after pregnancy.

There are symptoms of muscle mass due to tumor metastasis to other organs

A cough; go outside; bloody urination, headache ...

Gynecological examination

Uterus: Slow contraction, larger than normal, soft, can be palpable fibroblasts growing on the uterus.

Felt glandular cysts in one or both sides.

Vaginal metastases are common in the anterior wall, vestibule. The nucleus is purple, soft, painless, bleeding easily to the touch.

HCG test (diagnostic decision)

Urine hCG: Reaction Galli manini, Quick stick 25 IU, Organon 500 IU or 200 IU.

1 frog unit is equivalent to 30 - 35 international units.

serum hCG, b hCG serum.

Diagnosis is positive when

For two weeks, the b hCG concentration in the following week was higher than that of the previous week.

For three consecutive weeks, b hCG levels did not decrease.

Four weeks after curettage b hCG> 20,000 IU / L.

Two months after curettage b hCG> 500 IU / L.

Six months after curettage b hCG> 5IU / L.

Pathological anatomy

Species of uterus or vaginal metastases: invasive oocyte or cultured fibroblast cancer.

Other laboratory tests

Chest X-ray: The metastatic nucleus has a typical balloon-like appearance.

Ultrasound: Can show images of leukaemia nuclei cultured in uterine muscle, metastatic nucleus in the liver; kidney.

CT scan to detect brain metastases.

Classification of prognosis of cultured fibroblasts

Cultured cell carcinoma does not have metastasis.

Cultured fibroblast cancer has metastasis.

Good prognosis (low risk)

Urine hCG <100,000 IU / 24 h; serum hCG <400,000 mIU / ml.

Symptoms appear less than 4 months.

There is no brain or liver metastasis.

No previous chemical treatment.

Not after giving birth.

Bad prognosis (high risk)

Urine hCG> 100,000 IU / 24 h; serum hCG> 400,000 mIU / ml.

Symptoms appear less than 4 months.

There are brain and liver metastases.

There is chemical treatment before.

Postpartum often.

Prevention and treatment

Because the patient's risk is unknown, the general principle of prevention is to closely monitor the post-curettage patients for early diagnosis and timely treatment.

There are many methods of treatment, often a combination of methods aimed at:

Exclude cancer in place.

Kills cancer cells that have metastasized.

The main treatment methods:

Surgery

Completely cut the uterus

In order to remove the cultured fibroblast stem, sometimes there is no damage in the uterus, the uterus is still removed. Removing both ovaries when patients over 45 years old, under 45 years old, cutting or leaving two ovaries is considered case by case.

Complete hysterectomy for:

Old women with enough children.

Chemotherapy has not been successful.

Expect the metastatic nucleus

Human vaginal metastasis is usually taken easily, except for cases of metastasis close to the urethra, rectum. Pulmonary metastases if there are only a few nuclei in one lobe or one side of the lung can cut the lungs to remove the metastatic nucleus.

Chemical treatment

Point:

Young patient.

There are also aspirations to give birth.

Inability to operate.

Monotherapy: Methotrexate or Actinomycin D applies in the following cases:

Cultured cell carcinoma does not have a metastatic nucleus.

Cultured lymphoma has a metastatic nucleus but has a low risk.

Dosage: Methotrexate (MTX) 0.3mg / kg / day x 5 days; 7 -10 days off.

Or Actinomycin D 0.5 mg / kg / day for 5 days; 7 -10 days off.

Multi-therapy: Using a combination of chemicals. Applicable in the following cases:

Cultured fibroblasts have metastasized in a high-risk group.

Treatment with one chemical failed.

Monitoring of treatment: During the treatment phase, it is necessary to test:

The formula of blood, the formula of the daily transparency.

Liver and kidney function.

Blood sugar.

Quantitative hCG.

Symptoms of MTX chemical poisoning:

Dermatitis, ulcers of the oral mucosa, tongue; hair loss; diarrhoea...

Assay: WBC count <3,000 / mm3; Neutrophils below 1,500 / mm3, platelets less than 100,000 / mm3, serum transaminases increased.

When there are symptoms of poisoning, the chemotherapy treatment must be stopped immediately.

Symptoms of drug resistance: after each treatment, the hCG level did not decrease or increase, the appearance of more metastatic nucleus.

If there is evidence of resistance to drugs that require chemical changes or combinations, other measures such as surgery, radiation or radiation must be used to remove local cancer or metastasis.

Radiotherapy

It is common to use X-rays or cobalt to illuminate the hypotenuse or vagina to limit local cancer growth or metastasis.

Indications: Cancer spread in the pelvic fossa cannot be operated.

Criteria of cure and follow-up after treatment

Cured

Three weeks in a row hCG test was negative.

Test for hCG every 2 weeks for 3 months; then once a month for 3 months; followed by once every 2 months for 6 months; then every 6 months.

Gynaecological examination.

Chest X-ray every 3 months a year.

Avoid pregnancy for 2 years.

Recurrence rate

There is no metastatic cell cancer: 2%.

Cultured leukaemia has metastasis, good prognosis: 5%.

My blastoma has metastasis, poor prognosis: 21%.